Find Your Routine: Consistency is Key
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our new series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them.
This week, we talked with Crystal Junkins, CCS, CPC, Coding Specialist with Health Information Associates, about the steps she takes to find her routine.
Q: Describe in detail your daily routine.
A: I’m an early bird – and so is my baby. I am up at 5:30 to feed the baby and have my first cup of coffee. I make breakfast for the two of us, and then switch off baby duty with my husband and the dog and I head upstairs to my office by 7:00. I read emails and go through my pending charts list, and then code until coffee break around 10. I code again until lunch and then break to feed the baby, and let the dog out. I finish coding around 3 in the afternoon, and then head right out the door to pick up the older kids from school – and then it’s homework, various sports and music lessons, prepping and eating dinner, reading, and then bedtime.
Q: How do you maintain your routine day after day, week after week?
A: I think I am just naturally a creature of habit. Health is a real priority, eating right, taking care of myself, getting enough sleep… all of that helps me maintain a regular rhythm at work as well as in my personal life as a mom to 3 busy boys. Our family life is so full of various schedules and responsibilities that the daily/weekly routine is pretty much created for me.
As far as coding goes, one obstacle I have noted to maintaining a rhythm mainly occurs when I am switching to a new client. I have often found it very challenging to start at a new client, especially since it definitely slows down my productivity quite a bit at first. However, I know that it has been a great asset for me professionally to learn how to adapt quickly to new clients, new relationships, new software, and new ways of approaching coding. HIA is constantly pushing me to grow, and that’s definitely one of the things I love about working here! So when I am starting a new client, I try to take some time to figure out the best workflow for that particular site, as it can vary so much from one place to another. They all abstract a bit differently or store their documents and information in new places. And then once I get into a fluent workflow, I stick with it. I generally go through every chart exactly the same way (abstract/discharge disposition, admit order, CDI notes, H&P, Discharge Summary, Op notes, Consults, Progress notes, anesthesia notes, labwork/etc). I think being consistent in this way helps me hit my productivity numbers at a new client faster.
Q: What techniques have you found to minimize distractions?
A: One thing that is very helpful is just the location of my office in our home. I am upstairs tucked away in a spare bedroom, far from the kitchen and living room downstairs which is often a bustle of activity between the comings and goings of my husband, the dog, the 2 older boys, the baby and the nanny who watches him during the day while I work. I really can’t hear much of anything up there! I also leave my cell phone on the charger in the kitchen during the day and just check it when I come downstairs for lunch or coffee. I focus a lot better when it’s quiet, so I usually don’t have music playing either.
Q: What are the productivity goals that you set for yourself? And how do you track them?
A: Well – it’s great that HIA does the productivity tracking for me! I just try to log in and do my best every day. Some days seem to flow really smoothly and feel easily productive. And then some days… just feel really slow and challenging. I try not to worry about the numbers and just figure that the good and the bad days will balance each other out in the end.
Q: What motivates you the most? Positive feedback from managers, self-motivation by reaching personal goals, financing incentives? Or other?
A: Yes, all of those things are motivating. But mostly, I just like to end every day feeling like I did a good job. My dad told me that was the most important thing – and he’s right.
TIP: I know for sure that I am not the fastest chart reader around, but I am definitely a fast typer. I am a piano performance graduate – so I know I have a head for memorizing information and fast fingers.
I am sure typing fast helps a lot, but more importantly, I think I am always looking for ways to type less. I know that CAC programs can be controversial, but I definitely make use of it as a tool when I am working for a client who is utilizing auto suggested codes. I use the CAC codes as much as possible, when I am confident that the suggested codes are correct. At first I was hesitant to use the codes the CAC was suggesting, but now that I am becoming more familiar with the I10 codes, I can save a lot of time by entering the codes and POA status through the CAC instead of typing it all in. The fewer key strokes the better! I know my productivity has gone up since I started making better use of the CAC.
This would be considered a “mechanical” complication of the stent graft since the MD states it is a fracture of the endograft and it is folded over on itself. I would change T82.898A TO T82.598A for Other mechanical complication of other cardiac and vascular devices and implants, initial encounter. I did not use “displacement” because the surgeon did not state that the graft was displaced, only that it collapsed upon itself causing obstruction.
We interviewed our most productive coders and reviewers, asking them what steps they take to find a rhythm that works for them. This week, we talked with Valerie Abney, CDIP, RHIT, CCS, about the steps she takes to find her routine.
Osteoporosis alone is responsible for over a million fractures every year. Stress fractures are not as common but they do occur. There are more than 1 million total joint replacements in the U.S. each year, so there was a need to create codes for injuries that occur around or near the prosthesis. These are called “periprosthetic” fractures.
Back in April, the Office of the Inspector General (OIG) published a report detailing its findings from a review of two groups of high-risk diagnosis codes, acute stroke and major depressive disorder. The objective was to determine whether selected diagnosis codes submitted to the Centers for Medicare and Medicaid Services for use in CMS’s risk adjustment program complied with Federal requirements.
There seems to be differences of opinions on the issue of a 40w0day gestation Can you clarify if P08.21 should be assigned for 40w0day infant or if it would not be assigned unless the infant’s gestation age was 40w1day or greater?
Coders may find situations where a patient is documented as meeting SIRS or sepsis criteria, or has some clinical indicators reflective of possible sepsis, but the physician never documents sepsis as a diagnosis. Should the coder always query for sepsis in these instances?
In this example, would it be appropriate to code the complication code T82.03XA, Leakage of heart valve prosthesis, initial encounter as the principal diagnosis over the HFpEF (heart failure exacerbation) code?
We interviewed our most productive coders and reviewers, asking them what steps they take to find a rhythm that works for them. This week, we talked with Kerry Atkins, CDIP, CCS‑P, COC, CPC, CPCO, CPMA, CEMC, COBGC, RMB, Physician Services Consultant at HIA, about the steps she takes to find her routine.
A higher CMI corresponds to increased consumption of resources and increased cost of patient care, resulting in increased reimbursement to the facility from government and private payers, like CMS. We know that documentation directly impacts coding.
With the implementation of ICD-10-PCS more codes were developed in order to accurately report procedures. Spinal fusion coding is still a problematic coding issue and at times, even a coder’s nightmare. Coders often report only the code for the fusion thinking that one code would include all of the other procedures that are performed.
Answer: I would code 0HPT0NZ for removal of tissue expander from right breast, open and change 0HPT0JZ, removal of synthetic substitute from right breast, open, for removal of the acellular dermal matrix to 0HPT0KZ, Removal of nonautologous tissue substitute from right breast, open approach.
There are certain conditions that have instructional notes in the ICD-10-CM tabular/coding conventions that guide the coder in sequencing. This is especially true when the condition has a common manifestation or underlying conditions of a chronic disease. If there is a “code first” note in the tabular, the coder should follow this instruction and sequence the underlying etiology or chronic condition first followed by the manifestation as an additional diagnosis.
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and reviewers and asked them what steps they take to find a rhythm that works for them. This week, we talked with Meghan Schumacher, CPC, CPMA, Provider Coding Consultant at Health Information Associates, Inc., about the steps she takes to find her routine.
Last year, the Office of Inspector General (OIG) performed an investigation that found, “between 2014 and 2016, Medicare Advantage organizations overturned 75% of their preauthorization and payment denials upon appeal,” which is why, at HIA, we always advise our clients to engage in the appeals process.
There may be instances where a coder will suspect the patient has acute kidney injury (AKI), but the physician has failed to document the diagnosis. In another scenario, the physician may have made the diagnosis, but there is a question of clinical validity. In either case, a query would be justified.
Changes to CC/MCC designations included in the proposal could have a potentially dramatic effect on casemix. The presence of a major complication or comorbidity (MCC) or complication or comorbidity (CC) generally is representative of a patient that requires more resources.
How many times have you heard “it only takes one code to get the claim paid”? With the emphasis on the severity of illness and the move toward value-based reimbursement in today’s healthcare climate, it is more important than ever for coders to report all applicable diagnoses. There are three important pieces: what the provider documents, how to the coder interprets that documentation and codes it, and then how it is extrapolated.
The reimbursement landscape is already a complicated one – and the highly-complex claims denials process only adds fuel to the fire. A denied claim is one that has been determined by a payor to be in appropriate. Once a coding specialist amends the errors on a rejected claim, they can resubmit it for consideration. The time-intensive process has a significant impact on the cash flow for any setting in the healthcare environment. They are also very costly to appeal.
When a practitioner documents a diagnosis that does not appear to be supported by the clinical indicators in the health record, a coder has four choices: (1) Code the diagnosis; (2) Ignore the diagnosis; (3) Generate a query to confirm clinical validation of a diagnosis; (4) Follow the facility’s escalation policy for clinical validation.
A California-based healthcare services provider and several of its affiliates have agreed to pay $30 million to resolve allegations they submitted inaccurate information about the health status of beneficiaries enrolled in Medicare Advantage Plans, according to the Department of Justice.
Happy National Volunteer Week! This week we celebrate the impact volunteer work has on building stronger communities. We know that our staff have a positive impact while they’re on the job, and we are proud to share a few ways our #PeopleBehindTheNumbers are taking time to volunteer in their own local communities.
Scrutiny of coding compliance in the growing ambulatory surgical center (ASC) market has increased in recent years from both Medicare and private payers. This will only increase as the Centers for Medicare and Medicaid Services (CMS) moves towards value-based care.
Patients being admitted for acute renal failure due to dehydration have been happening for many, many years now. Typically what happens is a patient gets dehydrated for one reason or another. Once dehydration sets in, it can quickly start to affect many body organs. This can lead to acute renal/kidney failure/injury.
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Zahra Ghahremani, CCS, Coding Specialist at Health Information Associates, about the steps she takes to find her routine.
All queries require at least two elements – clinical indicators and a query question. Coders can also include multiple choice options for response or leave the query open-ended for a free text response. The order in which these elements are listed in a query is open to coder or facility preference.
Giving back is an important part of the HIA mission. Each year, HIA employees take a consensus and choose three National charities to support. Individuals can volunteer a portion of their wages to one of the three organizations. HIA Corporate will match each individual donation up to five dollars. We are proud to share with you our 2018 contribution totals combined with HIA matching funds.
One area that coders struggle with is when to report a separate condition code when an already assigned combination code includes the condition. For example, if an obstetric patient is admitted and delivers, and the physician documents “obstetric patient delivered with anemia,” should both code O99.02 Anemia complicating childbirth and D64.9, Anemia, unspecified be coded or should only O99.02 be assigned?
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Donna Cowan, RHIT, CCS, Coding Specialist at Health Information Associates, about the steps she takes to find her routine.
The key to choosing reasonable options for a query response is to remember that the query must stand alone. Any clinical indicators supporting the options must be included in the query itself. In this week’s Query Tip, we provide examples of two queries in which the options for response are not reasonable based on clinical indicators used by coder.